Chapter 5: UM, QM, & Accreditation

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Across
  1. 3. A function of concurrent UM, but it can also be an important element of case management
  2. 5. A list of drugs covering typical medical needs, although it does not include all available drugs for each medical condition
  3. 6. necessity A factor in coverage determinations when medical goods or services may or may not be covered depending on certain criteria
  4. 10. _______ is an initiative of the federal AHRQ that seeks to support the assessment of consumers’ experiences with healthcare
  5. 11. _______ utilization management refers to UM activities performed while care is being provided
  6. 12. Basic utilization management refers to the routine functions used to manage the cost of the most widely used _______
  7. 13. _______ management is a form of case management that focuses on a handful of selected conditions
  8. 14. _______ health care spans both the management of utilization and quality
  9. 15. Childhood immunizations are the most common form of _______
Down
  1. 1. _______ utilization management refers to UM or UM-related activities that take place after care has been provided
  2. 2. What types of medications do specialty pharmacies include?
  3. 4. Self-administered assessment tool used to quickly make an overall assessment of a new patient’s medical condition and risk factors
  4. 7. _______ -based clinical criteria and guidelines are based on formal medical studies and clinical trials that compare different approaches to care
  5. 8. Health plan _______ is a forma of oversight in which an independent, private, nonprofit organization reviews an MCO and determines if it meet certain criteria or industry standards
  6. 9. Payers quality management programs are _______